MYOMECTOMY PERFORMED CONCURRENTLY WITH TUBOPLASTY

OBJECTIVE: To determine whether women who require tuboplasty for infer tility and have associated uterine leiomyomas that require removal sho uld have the myomectomy done concurrently STUDY DESIGN: Eighty-nine in fertility patients underwent tuboplasty alone for proximal tubal obstr uction, 30 others were treated by both myomectomy and tuboplasty durin g the same operation, and 15 others underwent tuboplasty, leaving the myomas in situ. The tuboplasty in all cases consisted of tubal resecti on and anastomosis (TRA). The pregnancy rates and outcomes in the thre e groups were compared. RESULTS: Of the 89 patients who underwent TRA alone, 74.2% (66 patients) became pregnant, and of those 66, 15.2% had a spontaneous miscarriage, 24.2% developed an ectopic pregnancy, and 60.6% achieved a viable birth. By comparison, of 30 patients who had b oth TRA and myomectomy, 63.6% (19 patients) conceived, and of those 19 , 15.8% miscarried, 26.3% developed ectopic pregnancies, and 57.9% ach ieved viable births. Of 15 patients who underwent TRA leaving the myom as in situ, 73% (11) became pregnant, and of those 11, 45% (5) miscarr ied, 18% (2) had ectopic pregnancies and 36% (4) gave birth to viable infants. The incidence of pregnancies, ectopic gestations, miscarriage s and viable births in the three groups showed no statistical differen ces. CONCLUSION: When myomectomy is indicated, because of the lack of disadvantages of performing it at the time of tuboplasty, the combined surgical approach should be the procedure of choice rather than leavi ng the myomas in situ for their removal in a separate operation at a l ater date.